Poster Presentation Australian Diabetes in Pregnancy Society 2018

Facilitating best practice service changes: experiences of implementing a model of gestational diabetes mellitus care in dietetics (#134)

Shelley A Wilkinson 1 2 , Maxine O'Brien 3 , Sally J McCray 4 , Desley Harvey 5
  1. Mater Mothers' Hospital/Mater Medical Research Institute, South Brisbane, Qld, Australia
  2. Dietetics and Foodservices, Mater Health, Brisbane, Queensland , Australia
  3. Allied Health Acting Research Fellow & Alcohol and Other Drugs Services, Darling Downs Hospital and Health Service, Toowoomba, Queensland, Australia
  4. Director, Dietetics and Foodservices, Mater Health, Brisbane, Queensland, Australia
  5. Health Practitioner Principal Research Fellow & College of Healthcare Sciences, Cairns and Hinterland Hospital & Health Service and James Cook University, Cairns, Queensland, Australia

Aims: Translating research into clinical practice is a challenge for health services. Emerging approaches in implementation science recognise the need for a theory–driven approach to identify and overcome barriers to guideline adherence. However, many clinicians do not have the capacity, confidence, or expertise to realise change in their local settings. Recently, two regional sites participated in a facilitated implementation project of an evidence-based model of GDM care in dietetics, supported by a team at a metropolitan centre. This study describes (i) stakeholder experiences’, and (ii) learnings to inform implementation of the model of care (MOC) across Queensland. 

Methods: This qualitative study utilised semi-structured interviews. A purposive sample of practitioners was recruited from ‘core’ project members, including the GDM dietitian, self-nominated site project champion, dietetics project lead, plus key stakeholders. Eight participants were recruited; five from one site. Interviews explored project experiences from commencement to completion, barriers and enablers to project implementation, strategies to overcome challenges and recommendations for implementation at other sites. Interviews were recorded and transcribed. Two researchers independently coded, sorted, and synthesized all transcripts to derive themes which were shared with other investigators and agreed by discussion and consensus.

Results: Four main themes were derived: (1) catalyst for positive change, (2) managing project logistics, (3) overcoming barriers, and (4) achieving change.

Conclusion:  The findings suggest that a model of facilitated implementation using an evidence-based decision making tool is an effective method of fostering health service change and is acceptable to staff. In addition to methodological expertise, key elements of the facilitation should include building confidence and capacity of local implementers through regular contact, encouraging local networking, linking to higher management support and assessing and/or influencing workplace or organisational culture. However, the balance between delivering clinical care while participating in a service change project proved challenging to many participants.